Routine inspection·March 3, 2022

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, care staff Iverette "Joy" Villa, Marilou Barrola and toured the facility. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. This facility is licensed for a total of 6 non ambulatory residents, there are currently 5 residents in care, none receiving Hospice services. LPA toured facility and grounds and observed COVID-19 precaution signs posted in common areas to promote hand washing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms upon arrival to the facility. Infection control practices present: entry procedures, daily monitoring and temperatures checked for residents and staff, and 30-day PPE supply. Facility staff were observed wearing no mask, LPA requested staff to wear mask and follow Covid procedures and Mitigation plan at all times. Facility to follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test. Facility states staff clean and disinfect the facility daily. Bathrooms are equipped with liquid soap and paper towels. Covid-19 Mitigation plan will be reviewed. Caregivers have completed PPE training but have not been N-95 Fit tested. In addition, facility was found to be clean at a comfortable temperature with all exits free from obstruction. Facility has at least two days of perishable and one week of non-perishable foods and items are stored properly. Fire Extinguisher was found to be charged, but last serviced 2/16/2021. During today's inspection staff S1 had the proper fingerprint clearance but was not properly associated to this facility as required Continue report see LIC809-C The facility Administrator has changed and the facility has not submitted paperwork to Community Care Licensing (CCL) for the change. It was also reported to CCL, there has been facility ownership changes and LPA previously called and left a message for Suzzette Tawzler, that a New License may be required and an Application must be submitted immediately if there is a change of Ownership. Licensee Suzette Tawzler was not present during the inspection and spoke with LPA by phone. Licensee gave care staff approval to sign licensing reports. A civil penalty for $100.00 is issued during todays visit, for facility failure to Associate staff S1 to this facility prior to working as required. Facility staff to get N95 fit tested Send in updated LIC500 Personnel Report Send in LIC308 Designation of Responsability See LIC809-D for: Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Appeal rights and report will be emailed today to facility, due to technical issues. .